Healthcare Provider Details

I. General information

NPI: 1417113242
Provider Name (Legal Business Name): DAVID EDWARD USDAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 67TH ST
NEW YORK NY
10065-5964
US

IV. Provider business mailing address

151 E 67TH ST
NEW YORK NY
10065-5964
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-9500
  • Fax:
Mailing address:
  • Phone: 212-988-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number011281-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: